Saturday, 18 May, 2024

31 Jan 2014 | Auxiliary

news > News and Events > Page 10

New Oral-B 3D White Whitestrips provide a useful adjunct to in-office or at home bleaching treatments

By Prof. Laurence Walsh

New Products Whitening Teeth whitening

Oral-B has entered the competitive tooth whitening market with its new 3D White Whitestrips range that offers dental professionals a new option for patients looking to gain and maintain a whiter smile. Oral-B 3D White Whitestrips follow the highly successful Crest Whitestrips developed in the US by parent company Procter & Gamble.


Offering a sustained release of hydrogen peroxide (HP), Whitestrips provide a valuable addition to the group of measures which patients can undertake after completing in-office or professional supervised home bleaching treatments (Table 1). Lifestyle advice designed to reduce extrinsic staining typically focuses on avoiding highly coloured foods and those containing tannins and other highly adherent coloured substances (Table 2), but this advice is often rather impractical, given a patient's preferences for foods and beverages, and the difficulty in changing long standing behaviours which are inherently pleasurable.



Table 1. Advantages


For the patient

  • Lower cost than gel in custom trays
  • Simple application method
  • Minimal peroxide ingestion
  • Minimal adverse soft tissue effects
  • Safe if used for extended periods
  • No damage to tooth structure

For the dental professional

  • High patient compliance
  • Proven effectiveness
  • Can be applied selectively to teeth
  • Controlled delivery ensures correct delivery to tooth surface
  • Less chairside time as impressions and tray fabrication are not required



Table 2. Advice following professional bleaching treatments


Immediately after treatment (for the first 24 hours)

  • Avoid highly coloured foods (e.g. soy sauce and other coloured condiments)
  • Avoid acidic foods (e.g. black cola drinks)
  • Avoid smoking

Long term

  • Avoid tannin-containing drinks in the diet (tea, coffee, red wine, etc)
  • Avoid sustained use of antibacterial rinses which can cause staining (i.e. those containing chlorhexidine or cetyl pyridinium chloride)
  • Use a dentifrice with proven stain removal/stain reducing capabilities
  • Use a sustained delivery peroxide product to decolourise external stains


Patients will however be amenable to simple and inexpensive home care measures which will allow them to continue to have coloured foods and their preferred beverages, yet will mitigate against the extrinsic staining these will inevitably cause. The two best ways of doing this, which are not mutually exclusive, are to choose the appropriate dentifrice (toothpaste) to reduce the levels of external stain and to decolourise the stains which do develop, while at the same time providing an ongoing level of treatment of intrinsic stains. The former measure will be addressed in the accompanying Problems and Solutions article in Auxiliary (Jan/Feb 2014), while the present article will examine the latter aspect - specifically the use of adhesive whitening strips.

Technology overview

Oral-B 3D White Whitestrips are a polyethylene-based strip. The surface contains a thin (0.13mm thick) layer of 6% hydrogen peroxide, which is released through the adhesive to give a high concentration at the tooth surface, but minimal exposure to the saliva or to the gingival soft tissues. This novel design focuses the effect of the peroxide onto the teeth. The application method is very straightforward (Figure 1). The strips are removed from a sealed foil pouch and then peeled away from their backing, applied onto the labial enamel surface and pressed gently into place. The upper part of the strip is aligned with the interdental papillae. The remainder of the strip if folded over the incisal edges onto the palatal or lingual surfaces. The strips are left in place for 30 minutes and can be applied twice a day. At the end of the treatment period they are simply peeled off and discarded. Any traces of remaining gel on the teeth are removed by rinsing, wiping or brushing.

Effectiveness

The evidence base around hydrogen peroxide-containing adhesive whitening strips dates back to the year 2000, when they were first released on the market by Procter & Gamble in the US as Crest White Strips.1 High resolution microscopic studies of the effects of the HP gel which forms the active ingredient of these strips revealed that neither the enamel surface, the dento-enamel junction (DEJ), nor the dentine showed any significant morphological changes, despite undergoing a significant change in shade.2 Later studies measured both changes in tooth shade, surface morphology and surface microhardness both under the recommended use conditions and under excessive use (continuous contact for up to 70 hours). Surface hardness measurements showed no reduction, which indicated complete preservation of normal enamel surface structure.3

More than a dozen years of clinical trial evidence accumulated since the year 2000 supports the effectiveness of Oral-B Whitestrips in improving tooth shade and in helping retain this benefit over time. This underpins the use of Whitestrips to support professional bleaching treatments, leveraging their simplicity and ease of use properties.4 One of the seminal studies in this area was the study of Gerlach et al.5 This randomized, placebo-controlled double blind clinical trial evaluated both the initial tooth colour improvement after 2 weeks and post-treatment colour retention at 6 months in 57 healthy adults, whose maxillary and mandibular anterior teeth were treated twice daily for 30 minutes over 2 weeks. The whitening strip group experienced a highly significant reduction in yellow colour, a benefit which was largely retained at 6 months post-treatment. Of note, younger subjects experienced a greater initial reduction in yellowness compared to older participants, but the treatment benefits were maintained to the same extent in both older and younger subjects.

Safety

Whitestrips are well tolerated, with minor tooth sensitivity and minor oral irritation during treatment the two most commonly reported findings in the literature. Several clinical studies have revealed that the rate of these two minor adverse reactions is lower than that experienced by subjects having professionally supervised HP or carbamide peroxide home whitening treatments and typically only 10-12% of patients experience such issues.6-8 The reasons for the much better tolerability of Whitestrips than peroxide gels in trays relate primarily to the extent of soft tissue contact with HP. For professionally dispensed, take-home whitening products which comprise a vacuum-formed tray into which the patient dispenses a carbamide peroxide or HP-containing gel, the variables of patient loading (volume of material dispensed) and tray design (scalloped or not) influence how much gel comes into contact with the gingival soft tissues, particularly the labial aspect of the interdental papilla. Gels contain a high total dose of HP due to the combination of volume multiplied by concentration and much of this can come into contact with soft tissues as well as with saliva. Whitestrips, on the other hand, have a small volume of gel and limited area for saliva contact. Consequently, more HP is released directly against the enamel and there is less opportunity for inactivation by enzymes such as catalase and hydrogen peroxide in saliva, or catalase in gingival crevicular fluid.

In terms of the gingival soft tissues, the degree of irritation is a function of the dose of hydrogen peroxide to which the tissues are exposed, taking into account volume, concentration and contact time. Again, because Whitestrips have a low total dose of hydrogen peroxide, as well as a gradual sustained release and minimal contact with soft tissues, the direct exposure of the gingival to HP is very limited.9-10 This is one of the greatest advantages of strip-based whitening technology.

The same low total hydrogen peroxide dose and sustained release properties explain why Whitestrips do not cause adverse effects on the enamel surface, nor on the surface of dental restorative materials, when assessed using scanning electron microscopy or microhardness testing. This holds true not only for the manufacturer's recommended clinical use protocols, but also for excess bleaching at up to five times the suggested frequency.11-12 Likewise, levels of HP released into saliva are less for Whitestrips than for patients using vacuum formed trays.13

Patient acceptance

Since the invention of thin adhesive whitening strips with HP by Procter & Gamble, other delivery systems for at-home use have been developed, including paint-on products with HP, and a sodium percarbonate brush-applied gel that dries as a film and then breaks down to release HP. Comparative studies of these various alternatives indicate the superiority of Whitestrips in terms of the greatest positive effects on tooth shade, both initially and over 18 months post-treatment.14-15 Similar comparisons of Whitestrips to whitening dentifrices containing micropolishing particles also show that strip use for 30 minutes, twice daily for 2 weeks, gives greater changes in tooth shade and better retention of the colour change benefit over time.16

In North America, Whitestrips have proven to be popular with patients for at-home use as a "touch up" treatment and are preferred over conventional approaches such as applying 18% carbamide peroxide whitening gels. Comparisons of patient acceptability and preference for home products reveal not only better scores for Whitestrips in terms of reduction in yellowness and improvements in brightness, but also higher satisfaction ratings with the ease of use of the product and with the benefits gained.17 Their inherently high safety and tolerability, even when used for extended periods of time, make them unique amongst the range of professionally supplied options for maintenance care after professional bleaching treatments. This point is aptly demonstrated in studies which show they are effective and safe to use even in patients with medication-induced salivary dysfunction,18 who have longer clearance times for any dental products introduced into the oral cavity.

Conclusions

The use of Whitestrips as a professionally recommended method for patients to use at home is well supported by evidence of both effectiveness and safety. The evidence includes not only numerous randomised clinical trials over 14 years but also meta-analyses.19 They offer a number of particular advantages (Table 1) over other professionally recommended and supplied materials which could be used as adjuncts to professional whitening treatments. Whitestrips have proven popular in the North American market and one can expect in a similar manner that clinicians in Australia will find them a valuable addition to their clinical toolbox of recommended products for at-home use.



Table 3. Comparison of professionally supplied or recommended take-home whitening products


Product TypeProduct NameManufacturerKey Ingredient Application time

Strips3D White WhitestripsOral-BHydrogen peroxide 6% 2 X 30 mins

Paint-onPolapaintSDICarbamide peroxide 8% 30 mins

Paint-on varnishVivastyleIvoclarHydrogen peroxide 6% Left in place

PenZoom!PhilipsHydrogen peroxide 5.25% 30 mins

Gel in custom trayVivastyleIvoclarCarbamide peroxide 10 or 16% 60 mins

Gel in custom trayPoladaySDIHydrogen peroxide 3, 7.5, or 9.5% 30-60 mins

Gel in custom trayPoladay CPSDICarbamide peroxide 35% 15-30 mins

Gel in custom trayPolanightSDICarbamide peroxide 10, 16, or 22% 45 mins to overnight

Gel in custom trayVisible WhiteColgateHydrogen peroxide 6% 30 mins

Gel in custom trayZoom! Day WhitePhilips Hydrogen peroxide 6% 30-60 mins

Gel in custom trayZoom! Night WhitePhilips Carbamide peroxide 10 or 16% 45 mins to overnight

Gel in custom traySpeed WhiteningPlus WhiteHydrogen peroxide 6% 20 mins

Gel in custom trayNatural+Natural+Hydrogen peroxide 6% 60 mins

Gel in custom trayOpalescenceUltradentCarbamide peroxide 10, 15, 20 or 25% 30 mins to overnight

Gel in custom trayBiancoGunz DentalHydrogen 6% or Carbamide peroxide 10 or 18% 30 mins to overnight

Gel in self formed trayStayWhiteBeyondHydrogen peroxide 6% 60 mins


References

  1. Dorfman WM. News from Procter & Gamble (P&G) introducing Crest Whitestrips, their new over-the-counter whitening product. J N J Dent Assoc. 2000;71(4): 7-10.
  2. White DJ, Kozak KM, Zoladz JR, Duschner HJ, Gotz H. Effects of tooth-whitening gels on enamel and dentin ultrastructure--a confocal laser scanning microscopy pilot study. Compend Contin Educ Dent Suppl. 2000;(29):S29-34.
  3. White DJ, Kozak KM, Zoladz JR, Duschner H, Gotz H. Peroxide interactions with hard tissues: effects on surface hardness and surface/subsurface ultrastructural properties. Compend Contin Educ Dent. 2002;23(1A):42-8.
  4. Gerlach RW. Shifting paradigms in whitening: introduction of a novel system for vital tooth bleaching. Compend Contin Educ Dent Suppl. 2000;(29):S4-9.
  5. Gerlach RW, Gibb RD, Sagel PA. Initial color change and color retention with a hydrogen peroxide bleaching strip. Am J Dent. 2002;15(1):3-7.
  6. Karpinia KA, Magnusson I, Sagel PA, Zhou X, Gerlach RW. Vital bleaching with two at-home professional systems. Am J Dent. 2002;15 Spec No:13A-18A.
  7. Gerlach RW, Zhou X, McClanahan SF. Comparative response of whitening strips to a low peroxide and potassium nitrate bleaching gel. Am J Dent. 2002;15 Spec No:19A-23A.
  8. Gerlach RW, Sagel PA. Vital bleaching with a thin peroxide gel: the safety and efficacy of a professional-strength hydrogen peroxide whitening strip. J Am Dent Assoc. 2004; 135(1):98-100.
  9. Gerlach RW. Whitening paradigms revisited: introduction of a thin and concentrated peroxide gel technology for professional tooth whitening. Compend Contin Educ Dent. 2004;25(8 Suppl 2):4-8.
  10. Sagel PA, Landrigan WF. A new approach to strip-based tooth whitening: 14% hyd. peroxide delivered via controlled low dose. Compend Contin Educ Dent. 2004;25(8 Suppl 2):9-13.
  11. Duschner H, Gotz H, White DJ, Kozak KM, Zoladz JR. Effects of hydrogen peroxide bleaching strip gels on dental restorative materials in vitro: surface microhardness and surface morphology. J Clin Dent. 2004;15(4):105-11.
  12. Yalcin F, Gurgan S. Effect of two different bleaching regimens on the gloss of tooth colored restorative materials. Dent Mater. 2005;21(5):464-8.
  13. Yalcin F, Gurgan S.Hannig C, Zech R, Henze E, Dreier S, Attin T. Peroxide release into saliva from five different home bleaching systems in vivo. Am J Dent. 2005;18(1):13-8.
  14. Bizhang M, Muller M, Phark JH, Barker ML, Gerlach RW. Clinical trial of long-term color stability of hydrogen peroxide strips and sodium percarbonate film. Am J Dent. 2007;20 Spec No A:23A-27A.
  15. Xu X, Zhu L, Tang Y, Wang Y, Zhang K, Li S, Bohman LC, Gerlach RW. Randomized clinical trial comparing whitening strips, paint-on gel and negative control. Am J Dent. 2007;20 Spec No A:28A-31A.
  16. Yudhira R, Peumans M, Barker ML, Gerlach RW. Clinical trial of tooth whitening with 6% hydrogen peroxide whitening strips and two whitening dentifrices. Am J Dent. 2007;20 Spec No A:32A-36A.
  17. Lo EC, Wong AH, McGrath C. A randomized controlled trial of home tooth-whitening products. Am J Dent. 2007;20(5):315-8.
  18. Papas AS, Kugel G, Singh M, Barker ML, Gerlach RW. Placebo-controlled clinical trial of use of 10% hydrogen peroxide whitening strips for medication-induced xerostomia. Gerontology. 2009;55(5):511-6.
  19. Gerlach RW, Barker ML, Karpinia K, Magnusson I. Single site meta-analysis of 6% hydrogen peroxide whitening strip effectiveness and safety over 2 weeks. J Dent. 2009;37(5):360-5.

Clinical

Staying Safe

Staying Safe

Staying Safe

Stream the latest dental videos...
Expert talk: Freedom in movement

Upcoming Events...

May 22 2024
May 24 2024
May 29 2024
May 30 2024
May 31 2024

Scottish Dental Show 2024

Glasgow, UNITED KINGDOM

May 31 2024

Famdent Show Mumbai 2024

Mumbai, INDIA

Jun 01 2024
Jun 06 2024
Jun 09 2024
Jun 11 2024
Jun 19 2024
Jun 22 2024
Jul 13 2024
Jul 16 2024
Jul 25 2024
Aug 23 2024
Aug 29 2024

Practical Endodontics Workshop

Sydney, AUSTRALIA

Sep 07 2024
Sep 14 2024
Sep 26 2024
Oct 03 2024
Oct 10 2024
Oct 17 2024

ADOHTA 2024 National Congress

Sydney, AUSTRALIA

Oct 24 2024
Nov 07 2024

Veneers: A Comprehensive Guide

Auckland, NEW ZEALAND

Nov 13 2024
Nov 29 2024
Mar 25 2025

IDS 2025

Cologne, GERMANY

May 08 2025